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Single centre analysis of perioperative complications in trans-oral robotic surgery for oropharyngeal carcinomas

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Trans Oral Robotic Surgery (TORS) is a modality in the management of oropharyngeal squamous cell carcinoma(OPSCC). This study was conducted to show the rates of peri-operative complications after TORS for OPSCC in our experience. Single centre retrospective analysis of consecutive OPSCC treated with TORS. The surgical complication severity was recorded according to Clavien-Dindo criteria (CDC). Eighty-seven OPSCC were operated with TORS. According to CDC, grade I, grade II and IIIb were registered in 8%, 4.6% and 11.5% of cases, respectively. The postoperative pain, registered with visual-analogue scale (VAS) score, was 8 ± 1.2 for the secondary healing wounds and 6.2 ± 1.5 for the flap reconstructions (p < 0.01). The impact on swallowing function was not significant between secondary healing and flap reconstructions(p = 0.96). Any major or life-threatening intraoperative complications have not been recorded. Only one patient had postoperative bleeding into the neck whilst 13.3% of patients had postoperative bleeding from the primary tumor. No total local or free flap failure were registered. The mean duration of tracheostomy use was 7.4 ± 2.6 days, and nasogastric tube 14.3 ± 6.9 days. Only one patient, who had also reconstruction with flap, experienced a postoperative severe dysphagia with severe aspiration, needing a permanent tracheostomy tube and percutaneous endoscopic gastrostomy feeding. TORS for OPSCC showed less morbidity, lower risk of severe complication and mortality. Thus, this treatment modality could be offered as first line treatment in selected cases.

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References

  1. Meccariello G, Cammaroto G, Iannella G, De Vito A, Ciorba A, Bianchini C et al (2022) Transoral robotic surgery for oropharyngeal cancer in the era of chemoradiation therapy. Auris Nasus Larynx 49:535–546

    Article  PubMed  Google Scholar 

  2. Gal TJ, Slezak JA, Kejner AE, Chen Q, Huang B (2019) Treatment trends in oropharyngeal carcinoma: surgical technology meets the epidemic. Oral Oncol 97:62–68

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Chillakuru Y, Benito DA, Strum D, Mehta V, Saini P, Shim T et al (2021) Transoral robotic surgery versus nonrobotic resection of oropharyngeal squamous cell carcinoma. Head Neck 43:2259–2273

    Article  PubMed  Google Scholar 

  4. Lee SY, Park YM, Byeon HK, Choi EC, Kim SH (2014) Comparison of oncologic and functional outcomes after transoral robotic lateral oropharyngectomy versus conventional surgery for T1 to T3 tonsillar cancer. Head Neck 36:1138–1145

    Article  PubMed  Google Scholar 

  5. Ford SE, Brandwein-Gensler M, Carroll WR, Rosenthal EL, Magnuson JS (2014) Transoral robotic versus open surgical approaches to oropharyngeal squamous cell carcinoma by human papillomavirus status. Otolaryngol Head Neck Surg 151:606–611

    Article  PubMed  Google Scholar 

  6. Zevallos JP, Mitra N, Swisher-McClure S (2016) Patterns of care and perioperative outcomes in transoral endoscopic surgery for oropharyngeal squamous cell carcinoma. Head Neck 38:402–409

    Article  PubMed  Google Scholar 

  7. Stokes W, Ramadan J, Lawson G, Ferris FRL, Holsinger FC, Turner MT (2021) Bleeding complications after transoral robotic surgery: a meta-analysis and systematic review. Laryngoscope 131:95–105

    Article  PubMed  Google Scholar 

  8. Chia SH, Gross ND, Richmon JD (2013) Surgeon experience and complications with Transoral Robotic Surgery (TORS). Otolaryngol Head Neck Surg 149:885–892

    Article  PubMed  Google Scholar 

  9. de Almeida JR, Byrd JK, Wu R, Stucken CL, Duvvuri U, Goldstein DP et al (2014) A systematic review of transoral robotic surgery and radiotherapy for early oropharynx cancer: a systematic review. Laryngoscope 124:2096–2102

    Article  PubMed  Google Scholar 

  10. Hutcheson KA, Warneke CL, Yao CMKL, Zaveri J, Elgohari BE, Goepfert R et al (2019) Dysphagia after primary transoral robotic surgery with neck dissection vs nonsurgical therapy in patients with low- to intermediate-risk oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg 145:1053–1063

    Article  PubMed  PubMed Central  Google Scholar 

  11. Helman SN, Schwedhelm T, Kadakia S, Wang Y, Schiff BA, Smith RV (2015) Transoral robotic surgery in oropharyngeal carcinoma. Arch Pathol Lab Med 139:1389–1397

    Article  PubMed  Google Scholar 

  12. Dzięgielewski PT, Teknos TN, Durmus K et al (2013) Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg 139:1099–1108

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chen MM, Roman SA, Kraus DH, Sosa JA, Judson BL (2014) Transoral robotic surgery: a population-level analysis. Otolaryngol Head Neck Surg 150:968–975

    Article  PubMed  Google Scholar 

  14. Albergotti WG, Jordan J, Anthony K, Abberbock S, Wasserman-Wincko T, Kim S et al (2017) A prospective evaluation of short-term dysphagia after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Cancer 123:3132–3140

    Article  PubMed  Google Scholar 

  15. Meccariello G, Bianchi G, Calpona S, Parisi E, Cammaroto G, Iannella G et al (2020) Trans oral robotic surgery versus definitive chemoradiotherapy for oropharyngeal cancer: 10-year institutional experience. Oral Oncol 110:10488monnie

    Article  Google Scholar 

  16. Sgarzani R, Meccariello G, Montevecchi F, Gessaroli M, Melandri D, Vicini C (2020) Transoral robotic surgery (TORS) for head and neck squamous cell carcinoma: Healing by secondary intention, local flap or free flap. Eur J Plast Surg 43:123–128

    Article  Google Scholar 

  17. Monnier Y, Simon C (2015) Surgery versus radiotherapy for early oropharyngeal tumors: a never-ending debate. Curr Treat Options Oncol 16:42

    Article  PubMed  Google Scholar 

  18. Vicini C, Montevecchi F, D’Agostino G, Vito DE, A, Meccariello G. (2015) A novel approach emphasising intra-operative superficial margin enhancement of head-neck tumours with narrow-band imaging in transoral robotic surgery. Acta Otorhinolaryngol Ital 35:157–161

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  20. Meccariello G, Maniaci A, Bianchi G, Cammaroto G, Iannella G, Catalano A, Sgarzani R, De Vito A, Capaccio P, Pelucchi S, Vicini C (2022) Neck dissection and trans oral robotic surgery for oropharyngeal squamous cell carcinoma. Auris Nasus Larynx 49:117–125

    Article  PubMed  Google Scholar 

  21. Laccourreye O, Malinvaud D, Garcia D, Ménard M, Hans S, Cauchois R et al (2015) Postoperative hemorrhage after transoral oropharyngectomy for cancer of the lateral oropharynx. Ann Otol Rhinol Laryngol 124:361–367

    Article  PubMed  Google Scholar 

  22. White H, Ford S, Bush B, Holsinger FC, Moore E, Ghanem T et al (2013) Salvage surgery for recurrent cancers of the oropharynx: comparing TORS with standard open surgical approaches. JAMA Otolaryngol Head Neck Surg 139:773–778

    Article  PubMed  Google Scholar 

  23. Weinstein GS, O’Malley BW Jr, Snyder W, Sherman E, Quon H (2007) Transoral robotic surgery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 133:1220–1226

    Article  PubMed  Google Scholar 

  24. Rinaldi V, Pagani D, Torretta S, Pignataro L (2013) Transoral robotic surgery in the management of head and neck tumours. Ecancermedicalscience 7:359

    PubMed  PubMed Central  Google Scholar 

  25. More YI, Tsue TT, Girod DA, Harbison J, Sykes KJ, Williams C et al (2013) Functional swallowing outcomes following transoral robotic surgery vs primary chemoradiotherapy in patients with advanced-stage oropharynx and supraglottis cancers. JAMA Otolaryngol Head Neck Surg 139:43–48

    Article  PubMed  Google Scholar 

Download references

Funding

The authors have no relevant financial or non-financial interests to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Authors and Affiliations

  1. Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL Della Romagna, Viale Forlanini 34, 47100, Forlì, Italy

    Angelo Cannavicci, Eleonora Cioccoloni, Giovanni Cammaroto, Claudio Vicini & Giuseppe Meccariello

  2. Otolaryngology Unit, University of Ferrara, Ferrara, Italy

    Francesco Moretti, Andrea Ciorba, Chiara Bianchini, Virginia Corazzi & Claudio Vicini

  3. Department of ‘Organi Di Senso’, University “Sapienza”, Rome, Italy

    Giannicola Iannella

  4. Otolaryngology and Head-Neck Surgery Unit, Department of Surgery, Santa Maria Delle Croci Hospital, Azienda USL Della Romagna, Ravenna, Italy

    Andrea De Vito

  5. Burn Unit, Department of Surgery, Bufalini Hospital, Azienda USL Della Romagna, Cesena, Italy

    Rossella Sgarzani

  6. Maxillo-Facial Surgery Unit, Department of Surgery, Bufalini Hospital, Azienda USL Della Romagna, Cesena, Italy

    Manlio Gessaroli

  7. Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy

    Pasquale Capaccio

Authors
  1. Angelo Cannavicci
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  2. Eleonora Cioccoloni
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  3. Francesco Moretti
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  4. Giovanni Cammaroto
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  5. Giannicola Iannella
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  6. Andrea De Vito
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  7. Rossella Sgarzani
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  8. Manlio Gessaroli
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  9. Andrea Ciorba
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  10. Chiara Bianchini
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  11. Virginia Corazzi
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  12. Pasquale Capaccio
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  13. Claudio Vicini
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  14. Giuseppe Meccariello
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Contributions

Conception and design:G.M., C.V. Analysis and interpretation of data: A.C., E.C., F.M., G.C., Drafting of the manuscript: A.C., G.I., R.S., V.C. Revising it for important intellectual content: M.G., A.D.V., P.C. Final approval of the version to be published: P.C., A.C., C.B., C.V.

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Correspondence to Giuseppe Meccariello.

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Cannavicci, A., Cioccoloni, E., Moretti, F. et al. Single centre analysis of perioperative complications in trans-oral robotic surgery for oropharyngeal carcinomas. Indian J Otolaryngol Head Neck Surg 75, 842–847 (2023). https://doi.org/10.1007/s12070-023-03518-6

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  • DOI: https://doi.org/10.1007/s12070-023-03518-6

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